if you are not the dog's first owner, please describe dog's history as you know it

Have you trained a dog before? If so, when and where?

Please check any areas of concern:

BarkingChewingJumping UpHouse SoilingNippingNot ComingGrowlingBitingAfraid of ThunderAfraid of KidsAfraid of MenAfraid of MenAfraid of Other Dogs

Has your dog played/play with other dogs? Please explain

What family members will be attending class? (all welcome)

On a daily basis, what does your dog get for exercise?

MEDICAL INFORMATIONPlease complete this section fully or we will not be able to process your application. All dogs must be vaccinated for Distemper, Parvo and Rabies (Puppies after six months of age). Canine Cough is optional. The first Rabies shot is good for one year. Subsequent shots are good for three years. **Please either send or bring a copy of proof of vaccinations. Dogs will not be admitted without this.

Name of Veterinarian

Date of last Distemper/Parvo

Date of last Rabies

Date of last Canine Cough (if given)

InstructionsI hereby waive and release Bill Grant/Ultimate Companions, It's employees, officers, members and agents from any and all liability of any nature for injury or damage which I or my dog may suffer, including specifically, but without limitation, any injury or damage resulting from the action of any dog, and I expressly assume the risk of such damage or injury while attending any training session or any other function or while on the training grounds or the surrounding area thereto. In consideration of and as inducement to the indemnify and hold harmless Bill Grant/Ultimate Companions and it's employees, officers, members and agents from any and all claims or claims by any member of family or any other person accompanying me to any training session or function of Ultimate Companions or while on the grounds or the surrounding area thereto as a result of any action by any dog, including my own.

I have read the above and understand *Please type full name

Please remember to forward payment prior to the stat of class date. Payments should be made out and sent to:Bill Grant
PO Box 848
Putney, VT 05346